Visual Analytics • Analytical Monitoring • Information Management

Integrity Coordinator

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Assess Audit Risks and Performance

Did you know many managed care organizations effectively manage cost containment programs for their self-insured clients? 

Many firms implore plan administrators to conduct extensive claim audits.  In some cases these audits create unnecessary waste, expense and impede an otherwise productive and collaborative relationship with your carrier.

 

Our experts at Prothentix understand the challenges and complexity managed care organizations encounter with provider reimbursement.  Using our knowledge and visual analytics we can help plan sponsors determine whether plan assets have the appropriate oversight, possibly reducing the frequency or occurrence of claim audits.  We can provide you with tools and drill down capabilities to evaluate performance and identify outliers in your data that may require additional research and analysis with your carrier partner.

 

 

Integrity Coordinator

As a plan sponsor for a self-insured plan, have you contemplated any of the following:

      • Based on other observed performance, I sense my carrier effectively controls costs and has an acceptable level of payment accuracy. However, we need the ability to independently verify their performance.  Is there a less costly, less invasive, suitable and independent alternative to a claim audit?
      • I would like full access to a visual analytic solution to analyze provider reimbursements where I can collaborate and communicate with my carrier to resolve any cost or transactional outliers on a timely basis.
      • If I am required to do a claim audit or I have legitimate concerns, is there an analytics solution that can help me determine the scope, timing and extent of audit procedures that address the specific risks for my plan?

The experts at Prothentix understand the obligations plans must fulfill to ensure plan assets are spent accurately.  We also understand the complexities around provider reimbursements and reasonable timeframes it takes carriers to resolve payment errors.  We specifically design our visual analytics solution to evaluate carriers’ cost containment programs so you can make an informed decision on your audit needs.  If you would like to learn more, please register to see our brief video demonstrating our Integrity Coordinator visual analytics solution.

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Integrity Coordinator

As a plan sponsor for a self-insured plan, have you contemplated any of the following:

      • Based on other observed performance, I sense my carrier effectively controls costs and has an acceptable level of payment accuracy. However, we need the ability to independently verify their performance.  Is there a less costly, less invasive, suitable and independent alternative to a claim audit?
      • I would like full access to a visual analytic solution to analyze provider reimbursements where I can collaborate and communicate with my carrier to resolve any cost or transactional outliers on a timely basis.
      • If I am required to do a claim audit or I have legitimate concerns, is there an analytics solution that can help me determine the scope, timing and extent of audit procedures that address the specific risks for my plan?

The experts at Prothentix understand the obligations plans must fulfill to ensure plan assets are spent accurately.  We also understand the complexities around provider reimbursements and reasonable timeframes it takes carriers to resolve payment errors.  We specifically design our visual analytics solution to evaluate carriers’ cost containment programs so you can make an informed decision on your audit needs.  If you would like to learn more, please register to see our brief video demonstrating our Integrity Coordinator visual analytics solution.

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Have an Account? Log in Here »